No abstract available.
Lung Neoplasms* ; Lung* ; Pneumothorax*

PURPOSE: F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been proven to be useful in the differential diagnosis of breast mass and staging of breast cancer. This study assessed the diagnostic accuracy of F-18-FDG PET in the differentiation of breast mass and staging of breast cancer. MATERIALS AND METHODS: Total 42 patients who had breast mass underwent F-18-FDG PET (all female, 40+/-10 year old). We compared F-18 FDG PET results with pathologic findings in 24 patients RESULTS: In the differentiation of breast mass, sensitivity and specificity were 95% (19/20) and 77% (7/9) respectively. Three false positive cases were due to inflammation and one false negative patient had small tumor less than 1 cm. In the assessment of axillary lymph node status, sensitivity and specificity were 73% (8/11) and 100% (7/7) respectively. We found distant metastasis that were not suspected before F-18-FDG PET in 2 patients. CONCLUSION: F-18-FDG PET shows good diagnostic performance in differentiation of breast mass and staging of breast cancer.
Breast Neoplasms* ; Breast* ; Diagnosis, Differential* ; Female ; Humans ; Inflammation ; Lymph Nodes ; Neoplasm Metastasis ; Positron-Emission Tomography ; Sensitivity and Specificity

PURPOSE: Either gated myocardial perfusion SPECT or attenuation corrected SPECT can be used to improve specificity in the diagnosis of coronary artery disease. We investigated in this study whether gating or attenuation correction improved diagnostic performance of rest/stress perfusion SPECT in patients having intermediate pre-test likelihood of coronary artery disease. MATERIALS AND METHODS: Sixty-eight patients underwent rest attenuation-corrected T1-20l/dipyridamole stress gated attenuation-corrected Tc-99m-MIBI SPECT using an ADAC vertex camera (M:F=29:39, aged 59+/-12 years, coronary artery stenosis> or =70%. one vessel: 13, two vessel: 18, three vessel: 8, normal: 29). Using a five-point scale, three physicians graded the post-test likelihood of coronary artery disease for each arterial territory (1 normal, 2: possibly normal 3:equivocal, 4: possibly abnormal, 5: abnormal). Sensitivity, specificity and area under receiver-operating-characteristic curves were compared for each operator between three METHODS: (A) non-attenuation-corrected SPECT; (B) gated SPECT added to (A); and (C) attenuation-corrected SPECT added to (B). RESULTS: When grade 3 was used as the criteria for coronary artery disease, no differences in sensitivity and specificity were found between the three methods for each operator Areas under receiver- operating-characteristic curves for diagnosis of coronary artery disease revealed no differences between each modality (p>005). CONCLUSION: In patients at intermediate risk of coronary artery disease, gated SPECT and attenuation-corrected SPECT did not improve diagnostic performance.
Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Humans ; Perfusion* ; ROC Curve ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: For quantitative estimation of cerebrovascular reserve (CVR), we estimated the cerebral blood flow (CBF) using Lassen's nonlinearity correction algorithm and Tc-99m HMPAO brain SPECT images acquired with consecutive acquisition protocol. Using the values of CBF in basal and acetazolamide (ACZ) stress states, CBF increase was calculated. MATERALS AND METHODS: In 9 normal subjects (age: 72+/-4 years), brain SPECT was performed at basal and ACZ stress states consecutively after injection of 555 MBq and 1,110 MBq of Tc-99m HMPAO, respectively. Cerebellum was automatically extracted as reference region on basal SPECT image using threshold method. Assuming basal CBF of cerebellum as 55 ml/100 g/min, CBF was calculated for every pixel at basal states using Lassen's algorithm. Cerebellar blood flow at stress was estimated comparing counts of cerebellum at rest and ACZ stress and Lassen's algorithm. CBF of every pixel at ACZ stress state was calculated using Lassen's algorithm and ACZ cerebellar count. CVR was calculated by subtracting basal CBF from ACZ stress CBF for every pixel. The percent CVR was calculated by dividing CVR by basal CBF. The CBF and percentage CVR parametric images were generated. RESULTS: The CBF and percentage CVR parametric images were obtained successfully in all the subjects. Global mean CBF were 49.6+/-5.5 ml/100g/min and 64.4+/-10.2 ml/100g/min at basal and ACZ stress states, respectively. The increase of CBF at ACZ stress state was 14.7+/-9.6 ml/100g/min. The global mean percent CVR was 30.7% and was higher than the 13.8% calculated using count images. CONCLUSION: The blood flow at basal and ACZ stress states and cerebrovascular reserve were estimated using basal/ACZ Tc-99m-HMPAO SPECT images and Lassen's algorithm. Using these values, parametric images for blood flow and cerebrovascular reserve were generated.
Acetazolamide ; Brain* ; Cerebellum ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: Recently Tc99m MIBI (methoxyisobutylisonitrile) has been described as an alternative to thallium for localizing parathyroid lesions. The purpose of this study was to compare the efficacy of a Tc99m MIBI scan with a Tl201/Tc99m subtraction scan for localizing parathyroid lesions in patients with primary hyperparathyroidism. METHODS: Among 31 cases of primary hyperparathyroidism operated on at the Department of Surgery, Seoul National University Hospital from January 1997 to June 2001, a Tl201/Tc99m subtraction scan was performed on 16 patients and a Tc99m MIBI scan on 22 patients. Seven patients underwent both. RESULTS: The pathology was a single adenoma in 28 patients, a hyperplasia in 1 patient and a carcinoma in 2 patients. Hypercalcemia was controlled postoperatively in all cases. The sensitivities of the Tl201/Tc99m subtraction scan and Tc99m MIBI scan were 53.3% and 86.4%, respectively. The positive predictive values were 100% of the two study groups. CONCLUSION: We concluded that the better accuracy, superior image quality and lower cost of Tc99m MIBI scan will make it the new radiopharmaceutical parathyroid scan of choice. A unilateral approach can be used with a high degree of success, as in case of a preoperatively localized single parathyroid adenoma, which was confirmed when surgical exploration identified of a normal ipsilateral gland.
Adenoma ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary* ; Hyperplasia ; Parathyroid Neoplasms ; Pathology ; Seoul ; Thallium

PURPOSE: We evaluated the clinical/laboratory characteristics and progress of pediatric patients hospitalized for pneumonia and laboratory-confirmed H1N1 influenza infection. METHODS: A total of 101 patients were enrolled. They were divided into 2 groups: group 1 with a fast respiration rate for age (n=66) and group 2 with an appropriate respiration rate for age (n=35). We retrospectively reviewed the medical charts to collect data on the hospitalized patients. RESULTS: Patients were significantly older in group 1 than in group 2 (median age, 7 vs. 4 years, p<0.001) and 59.0% were between 6 and 8 years of age. Sixteen patients (24.2%) in group 1 had underlying medical conditions, most of whom had asthma, and 50 were previously healthy. Oxygen saturation on admission day was significantly lower in group 1 than in group 2 (92% vs. 98%, p<0.001) and 42 patients (63.6%) in group 1 had hypoxia (oxygen saturation <= 92%). The frequency of lymphopenia was significantly higher in group 1 than in group 2 (n=59 vs. 11, p<0.001). Some patients in group 1 received systemic corticosteroid therapy, intravenous immunoglobulin infusion and oxygen supplement (n=28, n=16, n=48, respectively). The frequency of systemic corticosteroid therapy and oxygen supplement was higher in group 1 than in group 2 (p<0.001 for each). CONCLUSION: H1N1 influenza infection complicated by pneumonia can cause severe illness in previously healthy children more than 6 years old and in children with uncontrolled allergic disease. Multi-center studies are needed to evaluate the clinical and epidemiologic characteristics of pediatric patients with 2009 H1N1 influenza.
Anoxia ; Asthma ; Child ; Humans ; Immunoglobulins ; Influenza, Human ; Lymphopenia ; Oxygen ; Pneumonia ; Respiratory Rate ; Retrospective Studies ; Tachypnea

PURPOSE: Interictal F-18-fluorodeoxyglucose (FDG) PET and ictal Tc-99m-HMPAO SPECT are found to be useful in localizing epileptogenic zones in neocortical lateral temporal or frontal lobe epilepsy. We investigated whether interictal F-18-FDG PET or ictal Tc-99m-HMPAO SPECT was useful to find epileptogenic zones in occipital lobe epilepsy (OLE). MATERIALS AND METHODS: We reviewed patterns of hypometabolism in interictal F-18-FDG PET and of hyperperfusion in ictal Tc-99m-HMPAO SPECT in 17 OLE patients (mean age=27+/-6.8 year, M:F=10:7, injection time=30+/-17 sec). OLE was diagnosed based on invasive electroencephalography (EEG) study, surgery and post-surgical outcome (Engel class I in all for average 14 months). RESULTS: Epileptogenic zones were correctly localized in 9 (60%) out of 15 patients by interictal F-18-FDG PET. Epiletogenic hemispheres were correctly lateralized in 14 patients (93%). By ictal Tc-99m-HMPAO SPECT, epileptogenic hemispheres were correctly lateralized in 13 patients (76%), but localization was possible only in 3 patients (18%). Among patients who showed no abnormality with MR imaging and no correct localization with ictal Tc-99m-HMPAO SPECT, interictal F-18-FDG PET was helpful in 2 patients. CONCLUSION:: Ictal Tc-99m-HMPAO SPECT was helpful in lateralization but not in localization in OLE. Interictal F-18-FDG PET was helpful for localization of epileptogenic zones even in patients with ambiguous MR or ictal SPECT findings. Key KW: Occipital lobe epilepsy, Tc-99m-HMPAO, Ictal perfusion SPECT, F-18-FDG, PET, SPECT
Electroencephalography ; Epilepsies, Partial* ; Epilepsy, Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Occipital Lobe* ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: This study was undertaken to learn the usefulness, cost-effectiveness and safety of intraoperative transesophageal echocardiography(ITEE) during open heart surgery for congenital heart diseases. METHODS: The usefulness and safety of ITEE were assessed in 254 patients who underwent open heart surgery for congenital heart diseases from January 1, 2001 to June 30, 2003, with retrospective chart reviews and a simple relative cost analysis. RESULTS: Among 254 open heart surgery patients, ITEE was not performed in 47 cases. The majority of cases were atrial septal defect(15 cases, 32%), ventricular septal defect(16 cases, 34%), ASD and VSD(three cases, 6.4%). In the other five smaller babies(weight range 2.7-3.1 kg), the ITEE probes couldn't pass the patient's esophagus. In 207 cases, ITEE were performed without any major complications. Residual abnormalities were identified by ITEE in six cases(2.9%), requiring surgical revisions : four cases with right ventricular outflow tract pressure gradient, one case of residual mitral regurgitation and one case of residual aortic stenosis and supravalvular pulmonary stenosis. If these six cases had not directly returned to bypass for surgical revision of the initial repair at the same operation, the additional fee of reoperation after leaving operation room were estimated to be won47,496,346(won7,916.057 per patient). In contrast, the costs of performing ITEE in all open heart surgical patients(207 patients) stood to total won82,800,000(won400,000 per patient). CONCLUSION: ITEE was not considered to be a beneficial diagnostic modality in terms of cost effectiveness in this study. But, the routine use of ITEE during most open heart surgery for congenial heart defects may be warranted as it produces no major complication, improves postoperative care, and comforts surgeon's feelings.
Aortic Valve Stenosis ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Echocardiography, Transesophageal* ; Esophagus ; Fees and Charges ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Mitral Valve Insufficiency ; Postoperative Care ; Pulmonary Valve Stenosis ; Reoperation ; Retrospective Studies ; Thoracic Surgery

PURPOSE: As vesicoureteral reflux (VUR) could lead to renal functional deterioration when combined with urinary tract infection, we need to decide whether operative anti-reflux treatment should be performed at the time of diagnosis of VUR. Predictive value of radioisotope voiding cystography (RIVCG) for renal outcome was tested. MATERIALS AND METHODS: In 35 children (18 males, 17 females), radiologic voiding cystourethrography (VCU), RIVCG and DMSA scan were performed. Change in renal function was evaluated using the follow-up DMSA scan, ultrasonography, and clinical information. Discriminant analysis was performed using individual or integrated variables such as reflux amount and extent at each phase of voiding on RIVCG, in addition to age, gender and cortical defect on DMSA scan at the time of diagnosis. Discriminant function was composed and its performance was examined. RESULTS: Reflux extent at the filling phase and reflux amount and extent at postvoiding phase had a significant prognostic value. Total reflux amount was a composite variable to predict prognosis. Discriminant function composed of reflux extent at the filling phase and reflux amount and extent at postvoiding phase showed better positive predictive value and specificity than conventional reflux grading. CONCLUSION: RIVCG could predict renal outcome by disclosing characteristic reflux pattern during various voiding phases.
Child ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Prognosis ; Sensitivity and Specificity ; Succimer ; Ultrasonography ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: To evaluate the effectiveness of radioiodine treatment for metastatic thyroid carcinoma, we reviewed results of radioactive iodine treatment in patients with functional lung or bone metastases. MATERIALS ANF METHODS: Of 760 patients who were treated for differentiated thyroid cancer between 1984 and 1998, we detected pulmonary metastases and bone metastases in 76 patients (10.0%) and 20 patients (2.6%), respectively. Among them, we could evaluate the effectiveness of I-131 therapy in 53 patients with lung metastases and 15 patients with bone metastases. RESULTS:Of 53 patients who received I-131 therapy with a mean cumulative dose of 26.2 GBq (1.1-84.4 GBq) for pulmonary metastases, metastatic lung lesions completely resolved in 19 patients (35.8%) and improved in 22 patients (41.5%). In 13 of 19 patients with complete remission of pulmonary metastases, the total accumulated dose of I-131 was less than 18.5 GBq. We found 43 sites of metastatic bone lesions in 15 patients with bone metastases. Of 29 lesions which received I-131 therapy, metastatic lesions improved in 14 sites (48.3%), but did not change or progress in 15 sites (51.7%) despite the I-131 therapy. Three lesions were completely cured with a combination treatment of surgery(+/- external radiotherapy) and I-131 therapy, and the other 11 lesions improved. CONCLUSION: Radioactive iodine treatment gives favorable results for pulmonary metastases. However, for bone metastases, there might be a need to use combination therapy including I-131 and surgery or external irradiation.
Atrial Natriuretic Factor ; Humans ; Iodine ; Lung ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms*